Despite the huge wealth of knowledge on which they are based, guidelines often fail to influence healthcare in the parts of the world where they are most needed. The majority of guidelines are currently produced by medical organizations in the developed world. By focusing on ‘gold standard’ diagnostic and treatment options, guidelines assume unlimited access to resources and funding and therefore are irrelevant in large areas of the world where the lack of fundamental infrastructure poses a severe limitation to medical practice. As such, many guidelines are ‘resource-blind’ and exclusive to the developed world. Moreover, guidelines may be particularly important in developing countries, where patients often have less input into their care and so doctors must be fully aware of all management options.² As an example, the American Gastroenterology Association (AGA) 2007 guidelines recommend the use of computed tomography scanning to diagnose and manage acute pancreatitis; however, this technology is unavailable in the majority of hospitals in resource-poor ountries. AGA 2007 algorithms also suggest the use of angiography and capsule endoscopy for the diagnosis of occult gastrointestinal bleeding, techniques unlikely to be used outside the developed world.³

Professor Suliman Fedail, a gastroenterologist based in Sudan, deals daily with esophageal varices caused by high levels of chronic hepatitis B infection. He highlights the impracticality of the recommended treatment in this setting: “Vasoactive drug therapy is unrealistic in most developing countries. These drugs are not available in district hospitals, and in Khartoum vials of Glypressin (1mg) cost the equivalent of 25% of the salary of a house physician.”

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